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Biomedical subjects

E Partio

Publications and source records attributed to E Partio.

At least 19 recordsLinked to original sources
PubMed1999

Bioabsorbable fixation in the treatment of proximal tibial osteotomies and fractures. A clinical study.

BACKGROUND AND AIMS: The purpose of this study was to evaluate the use of bioabsorbable implants in proximal tibia cancellous bone fixations in 28 patients. PATIENTS AND METHODS: The implants used were self-reinforced polyglycolide (SR-PGA) or self-reinforced polylactide (SR-PLLA) screws or rods. In six patients a high tibial osteotomy and in 16 patients a proximal tibial plateau fracture were secured with these implants (cancellous bone fixations). In addition, four anterior tibial eminence avulsion fractures and two tibial tuberosity avulsions were fixed (avulsion fractures). The average follow-up time was 3.6 years. RESULT AND CONCLUSIONS: In the cancellous bone fixations (15 patients at the follow-up) there were three excellent clinical results, five good, five moderate and two poor results; radiologically there were one excellent result, eight good, five moderate, and one poor result. In the avulsion fracture patients (four patients at the follow-up) there were two excellent and two good clinical results; radiologically all results were excellent. In four cancellous bone fixations redisplacement was noted. In all patients the functional score was 25.6/30 (Rasmussen 1973). The bioabsorbable implants can be used for fixation of proximal tibial cancellous bone osteotomies and fractures and avulsion fractures with good or moderate results.

Absorbable Implants↗
PubMed1995

Low molecular weight heparin (enoxaparin) compared with unfractionated heparin in prophylaxis of deep venous thrombosis and pulmonary embolism in patients undergoing hip replacement.

Prophylactic efficacy and safety of a low molecular weight heparin (LMWH) and those of conventional unfractionated heparin (UH) were investigated in a randomized study. Totally, 167 consecutive patients undergoing total hip replacement were allocated to two groups. Patients in the LMWH-group (n = 83) received a fixed dose of enoxaparin 40 mg once daily, starting 12 hours preoperatively and continuing for 10 days. Patients in the UH-group (n = 84) received UH 5000 IU twice a day subcutaneously (sc), starting two hours before operation and continuing for 10 days. Deep venous thrombosis (DVT) was diagnosed by bilateral ultrasonography and confirmed by venography. Proximal DVTs were observed in four patients of UH-group (4.8%) and in one of LMWH-group (1.2%, P > 0.05). There was only one pulmonary embolism (PE) in a patient belonging to UH-group (1.2%). Low rates of thromboembolic events could be explained, in addition to heparin prophylaxis, also by early mobilization and regional anaesthesia. Local tolerance (size of haematoma), blood loss and transfusion requirements during the operation and the postoperative period did not show differences between the two study groups. The results of our study indicate that enoxaparin once daily is an effective and safe form of DVT prophylaxis in patients undergoing elective hip replacement.

Aged↗
PubMed1994

Survival of the Townley knee. 360 cases with 8 (0.1-15) years' follow-up.

We evaluated 360 Townley arthroplasties in 167 OA and in 193 RA knees, performed between 1978-1986. 35 revisions were performed during the follow-up time. The main reasons for revision were aseptic loosening (18 knees), instability (6 knees), and infection (5 knees). The durability of different prosthesis components and of different tibial trays in relation to loosening were analyzed separately. The probability of the prosthesis remaining in situ was 94 percent after 5 years and 89 percent after 10 years. The success rate at 10 years was not significantly higher in arthrosis (94 percent) than in rheumatoid arthritis (85 percent). The other patient-related factors, age, sex, weight, did not influence the results. Comparing the different prosthesis components and the different designs of the tibial tray, we found no differences in success rates.

Adult↗
PubMed1994

Survival of the Lubinus hip prosthesis. An eight- to 12-year follow-up evaluation of 444 cases.

The Kaplan-Meier survival method was used to analyze 444 Lubinus arthroplasties in 398 patients who were observed between eight and 12 years. The indication for arthroplasty was osteoarthrosis in 316 hips, rheumatoid arthritis in 84 hips, and various other conditions for the other 44 hips. Survival was determined for the entire prosthesis, as well as separately for the femoral stem, the acetabulum cup, and their four subgroups. Four patient-related variables (diagnosis, gender, age, and weight) were analyzed. The overall survival of the Lubinus implants was 97.1% at five years and 87.1% at ten years. No significant difference in survival was found between the acetabular and femoral components. Survival was not significantly better with a new anatomic (SP1) stem than with the old curved one (IP). Of the four patient-related variables studied, only diagnosis and age had a significant effect on prosthesis survival. There was no difference in survival between osteoarthrosis and rheumatoid arthrosis hips, but survival was clearly poorer at ten years in the miscellaneous diagnosis group. The authors obtained a significantly lower survival percentage for patients younger than 65 years of age than for those 65 years and older. There were no deep postoperative infections in this series. The revision rate was 11.5%. The wear seen at the lower front edge of cups that were removed is discussed.

Age Factors↗
PubMed1992

Talocrural arthrodesis with absorbable screws, 12 cases followed for 1 year.

In 11 patients, 12 arthrodeses of the ankle joint were performed by using absorbable self-reinforced poly-l-lactide (SR-PLLA) or polyglycolide (SR-PGA) screws. 8 patients had posttraumatic arthrosis, 3 rheumatoid arthritis, and 1 rigid flexion contracture of the ankle due to neuropathy. The average follow-up time was 14 (7-22) months. Solid fusion was achieved in 11 of 12 cases in 9(6-16) weeks.

Absorption↗
PubMed1992

Foreign-body reactions to polyglycolide screws. Observations in 24/216 malleolar fracture cases.

Out of 216 patients with displaced malleolar fractures operated on using absorbable polyglycolide screws, 24 developed a transient local nonbacterial inflammatory reaction on an average 3 months after the operation. Upon histopathologic examination, these tissue responses were found to be nonspecific foreign-body reactions. Neither the age of the patient nor the number of screws used in the fixation affected the incidence of the reactions. The first-generation screws that were colored with an aromatic quinone dye showed a higher incidence, 19 reactions among 105 patients, than the new noncolored implants, 5 among 111 patients (P less than 0.01). No deleterious effect of these tissue responses on the union of the fractures could be detected, but the possible long-term consequences of this complication are so far unknown.

Adult↗
PubMed1992

[Resorbable rods and screws of polyglycolide in stabilizing malleolar fractures. A clinical study of 600 patients].

Absorbable internal fracture fixation implants have been in large-scale clinical use since 1984. The main advantage of these devices is that no subsequent operation for implant removal is required. In this study the results obtained in a series of 600 patients with displaced malleolar fractures who were operated on over a 6-year period (1985-1990) using rods or screws made of polyglycolide were analysed. Rod fixation was used in 63% and screw fixation in 37% of the patients. Recovery was uneventful in 91.5%. Bacterial wound infection occurred in 1.2% and failure of fixation necessitating reoperation in 0.8% (5 patients). In 4 of these 5 patients a refixation procedure with AO devices was performed. In one elderly patient with failed fixation talocrural arthrodesis had to be done. A sterile inflammatory foreign-body reaction complicated the course in 6.5%. The incidence of these reactions was higher during the early years of the study, when the implants contained an aromatic quinone dye, than later, when stain-free implants were used. The foreign-body reactions were transient and did not significantly influence the ultimate results of treatment. During the 6-year period the use of absorbable implants has made it possible for resources corresponding to several hundred hardware removal procedures to be used for other purposes.

Adolescent↗
PubMed1992

Degradation and tissue replacement of an absorbable polyglycolide screw in the fixation of rabbit femoral osteotomies.

Degradation and tissue replacement of a totally absorbable polyglycolide screw, 4.5 millimeters in diameter and thirty millimeters in length, were studied histologically, morphometrically, and radiographically at sequential stages of resorption at as long as thirty-six weeks after fixation of a transverse distal femoral osteotomy in rabbits. The initial mean shear force to failure was 95.0 newtons for the specimens that had been fixed with the polyglycolide screw compared with 257.0 newtons for the distal part of the contralateral, intact femur. The physical appearance of the screw was unaltered at three weeks. The first histological signs of degradation were seen at six weeks, along the thread ridge. Premature breakage of the screw resulted in gross displacement and non-union of the osteotomy in one animal. The degradation of polyglycolide was accompanied histologically by a typical non-specific foreign-body reaction. This kind of tissue response seemed to be associated with an osteolytic proximal expansion of the implant cavity that was suggestive of increased pressure within the cavity during degradation of the screw. In eight specimens, a wall of new bone formed around this area of osteolysis and demarcated the implant cavity from the surrounding normal cancellous bone. Seventy-four per cent of the periphery and 28 per cent of the central core of the screw had been resorbed at twelve weeks. At thirty-six weeks, no polymeric material could be discerned, and the predominant tissue component within the implant cavity was loose connective tissue. The volume fractions of trabecular bone and hematopoietic bone marrow were significantly lower (p less than 0.01) than those of the intact, control side, but the degree of restoration of tissue varied considerably from animal to animal.

Animals↗
PubMed1992

The tissue-implant interface during degradation of absorbable polyglycolide fracture fixation screws in the rabbit femur.

A transverse transcondylar osteotomy of the distal femur was fixed with an axially placed absorbable fracture fixation screw made of polyglycolide (PGA) in 25 rabbits. Changes at the tissue-implant interface accompanying degradation of the screw were examined histologically, histomorphometrically, and microradiographically seven, 20, 40, 80, and 250 days after implantation. At seven days postimplantation, a layer of fibroblasts was seen surrounding the implant, and new bone formation was discernible in the host tissues adjacent to this membranous structure. At 20 days postimplantation, the geometry of the screw was still intact and the tissue-implant boundary was distinct. The first signs of invasion of vascular granulation tissue into the implant were observed 40 days after implantation, at which time the osteotomies were united. The apparent walling-off response by formation of new trabecular bone outlining the PGA profile continued, with the greatest mean trabecular bone volume fraction at the interface, 23.9%, measured at 40 days. A significant decrease in the new bone volume occurred between 40 and 80 days postimplantation. The intensity of the foreign-body reaction seen was histologically moderate. The giant cell count was highest at 80 days postimplantation, when the migratory activity of phagocytic cells had transported intracellular particulate polymeric debris 400-800 microns away from the original tissue-implant boundary. At 250 days postimplantation, no birefringent polymeric material could be seen in the specimens. No contraindications for the clinical application of PGA implants emerged in this study.

Animals↗
PubMed1992

Hip fractures in two health care regions in Finland in 1989: an analysis of treatment.

We studied prospectively the demographic data, fracture types and modes of treatment in 390 patients with acute traumatic hip fractures in two health care regions in Finland, the Middle Finland region and the Kymenlaakso region in 1989. In Middle Finland population (251,203 inhabitants) 199 patients with a hip fracture were admitted to two acute care hospitals, while 191 patients were admitted in Kymenlaakso (population 189,726) to four acute hospitals. There were no significant differences in the sex- and age-specific incidences between the two regions. In Middle Finland, 70% of the fractures were of the femoral neck, 28% were trochanteric and 2% subtrochanteric. The corresponding figures in Kymenlaakso were 57%, 38% and 5% (P < 0.05). In Middle Finland, 73% of the femoral neck fractures were treated primarily with a hemiendoprosthesis, 2% with primary total hip replacement and 25% by osteosynthesis. The corresponding figures in Kymenlaakso were 81%, 7% and 12% (P < 0.001). The mean duration of hospital stay was 14 days in Middle Finland and 21 days in Kymenlaakso (P < 0.01).

Adult↗
PubMed1991

Impact of the use of absorbable fracture fixation implants on consumption of hospital resources and economic costs.

Within a 6-year period (1984-1989) absorbable pins, rods, and screws made of polyglycolide, polylactide, or lactide-glycolide copolymer were used in the internal fixation of 881 fractures, 73.1% of which were displaced malleolar fractures of the ankle. During the last 3 years the patients treated using absorbable fracture fixation constituted 19.6% of all fracture patients managed by internal fixation at the department. The number of hardware removal procedures avoided during the 6-year period as a result of the use of the absorbable implants was estimated at approximately 700. By determining all direct and indirect costs associated with internal fracture fixation and the influence of the percentage of hardware removal, a cost coefficient was calculated for certain fracture types when treated using absorbable versus metallic internal fixation. In bimalleolar fractures, an optimal indication for absorbable fixation, the coefficient was 1.04 (cost of absorbable fixation 4% higher than that of metallic fixation) if the removal percentage with metallic fixation was zero and 0.91 (cost of absorbable fixation 9% lower than that of metallic fixation) if the removal percentage was 100%. The breakeven point was a removal rate of 31%.

Absorption↗
PubMed1991

Absorbable polyglycolide screws in internal fixation of femoral osteotomies in rabbits.

In 20 rabbits, a transverse distal femoral osteotomy was fixed using a 4.5 by 30-mm absorbable screw made of polyglycolide. No postoperative external support was used. The consolidation of the osteotomy was investigated histologically, morphometrically, and microradiographically in groups of 4 to 6 rabbits that were followed for 3, 6, 12, or 36 weeks. Fourteen osteotomies showed solid bony union; and in 3, several bone trabeculae were seen to bridge a still partially ununited osteotomy. In another 3 rabbits, each with a follow-up time of 12 or 36 weeks, no convincing signs of progressing consolidation could be seen. Only 1 of these rabbits showed displacement of the distal fragment.

Animals↗
PubMed1990

Immune response to polyglycolic acid implants.

Cytological analysis of material aspirated from the effusion which occasionally develops around a polyglycolic acid (PGA) osteosynthesis implant showed a predominance of inflammatory monocytes and in particular lymphocytes. In order to discover whether PGA implants are immunologically inert, density gradient-isolated peripheral blood mononuclear cells were cultured in 0.2 ml of 10% delta FCS-RPMI 1640 culture medium supplemented with 10 mg PGA. Phytohaemagglutinin (PHA) lectin, a purified protein derivate of tuberculin (PPD) antigen and culture medium alone were used as positive and negative controls. We studied lymphocyte activation kinetics on days 0, 1, 3 and 5. Major histocompatibility complex locus II antigen (MHC locus II antigen) and interleukin-2 receptor (IL-2R) expression were analysed using the avidin-biotin-peroxidase complex (ABC) method and lymphocyte DNA synthesis by using 3H-thymidine incorporation and beta-scintillation counting. Especially on culture days 0 and 1, lymphocytes and monocytes were seen by light microscopy to be attached to PGA particles. However, our results show no PGA-induced lymphocyte DNA synthesis, but PGA-induced MHC locus II antigen and IL-2R activation marker expression was seen, greater than in negative controls, but less than that seen in PPD antigen driven lymphocyte response. This suggests that PGA is an immunologically inert implant material, but it does seem to induce inflammatory mononuclear cell migration and adhesion, leading to a slight non-specific lymphocyte activation. This activation is lower than that seen in mitogen and antigen-driven lymphocyte responses.

Cells, Cultured↗
PubMed1985

Impact of new imaging techniques on survival in cancer of the head of the pancreas and the periampullary region.

The impact of new imaging techniques on diagnostic delay and on survival in carcinoma of the head of the pancreas and the periampullary region was investigated. The study comprised 67 patients treated before (1968-1975) and 82 treated after (1979-1981) the introduction of new imaging techniques at Oulu University Central Hospital. The symptomatology, diagnostic delay and survival rates were identical in both groups, but the number of patients per year increased significantly during the latter period. The study indicated that the new imaging techniques, despite their increased diagnostic yield, did not influence diagnostic delay or survival in pancreatic and periampullary carcinoma.

Aged↗
PubMed1984

Pancreatic and periampullary carcinoma.

During the 10-year period from 1972 to 1981, 179 patients were treated for pancreatic and periampullary carcinoma (40 resections, 91 bypasses, 39 laparotomies and 9 non-operated) in Oulu University Central Hospital. Mortality after resections was 10% and complication rate 33%. In 1977-1981, mortality after resections decreased from 30 to 3% (p less than 0.05) but resectability or survival did not improve. Median survival following resection for pancreatic and periampullary carcinoma was 8 and 34 months (p less than 0.001). The 5-year cumulative survival rate for resected periampullary carcinomas was 42 +/- 16%. We conclude that 5-year survival after resection for periampullary carcinoma is significantly better than after resection for pancreatic carcinoma. The effect of modern imaging techniques on resectability and survival is negligible. Age as such is not a limiting factor for resection. We recommended a prophylactic duodenal bypass is conjunction of biliary diversion for unresectable carcinoma. The acceptable mortality after resection encourages us to continue an aggressive policy in surgical treatment. However, attention should be drawn to a more careful patient selection and proper preparation.

Adenocarcinoma↗
PubMed1978

Pyogenic spondylitis.

During the period 1972-1974 10 patients suffering from pyogenic spondylitis have been treated at the Central Hospital of Middle Finland. Three of the patients had become acutely ill with septic fever and back pain. In the remaining cases the onset of the disease was insidious. Fever, weight loss and fatigue were the general symptoms. Percussion revealed local tenderness at the site of infection in all patients. Two patients showed neurological signs. The ESR was elevated in all cases and alkaline phosphatase was elevated in six patients. Blood culture was positive in those three patients who had become acutely ill. Narrowing of the intervertebral space was observed in all patients. Scanning with Tc99 was performed in nine patients, seven of whom were at an early stage of the disease; a significant uptake was recorded in five of these cases. The average interval between the onset of symptoms and the diagnosis was 3 months, range 1 to 5 months. The treatment consisted of bed rest and antibiotics. All the patients recovered and became symptom-free.

Blood Sedimentation↗